MEDICARE: VIDACARE MEDICAL TRANSPORTATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1437001120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIDACARE MEDICAL TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	4200 PECK RD STE B
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-2177
Country	:	US
Telephone Number	:	626-673-5439
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 PECK RD STE B
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-2177
Country	:	US
Telephone Number	:	626-673-5439
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. GREGORIO JIMENEZ JR.
Credential	:
Telephone Number	:	626-673-5439

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/13/2026

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